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WO2018191472A1 - Promédicaments de levoranol et leurs procédés de fabrication et d'utilisation - Google Patents

Promédicaments de levoranol et leurs procédés de fabrication et d'utilisation Download PDF

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Publication number
WO2018191472A1
WO2018191472A1 PCT/US2018/027258 US2018027258W WO2018191472A1 WO 2018191472 A1 WO2018191472 A1 WO 2018191472A1 US 2018027258 W US2018027258 W US 2018027258W WO 2018191472 A1 WO2018191472 A1 WO 2018191472A1
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Prior art keywords
levorphanol
composition
acid
structural formula
following structural
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PCT/US2018/027258
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English (en)
Inventor
Travis Mickle
Sven Guenther
Sanjib Bera
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Kempharm, Inc.
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Priority to US16/604,626 priority Critical patent/US20210002226A1/en
Publication of WO2018191472A1 publication Critical patent/WO2018191472A1/fr

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    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
    • C07D221/00—Heterocyclic compounds containing six-membered rings having one nitrogen atom as the only ring hetero atom, not provided for by groups C07D211/00 - C07D219/00
    • C07D221/02—Heterocyclic compounds containing six-membered rings having one nitrogen atom as the only ring hetero atom, not provided for by groups C07D211/00 - C07D219/00 condensed with carbocyclic rings or ring systems
    • C07D221/22—Bridged ring systems
    • C07D221/28—Morphinans
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
    • C07D215/00—Heterocyclic compounds containing quinoline or hydrogenated quinoline ring systems
    • C07D215/02—Heterocyclic compounds containing quinoline or hydrogenated quinoline ring systems having no bond between the ring nitrogen atom and a non-ring member or having only hydrogen atoms or carbon atoms directly attached to the ring nitrogen atom
    • C07D215/04—Heterocyclic compounds containing quinoline or hydrogenated quinoline ring systems having no bond between the ring nitrogen atom and a non-ring member or having only hydrogen atoms or carbon atoms directly attached to the ring nitrogen atom with only hydrogen atoms or radicals containing only hydrogen and carbon atoms, directly attached to the ring carbon atoms
    • C07D215/06—Heterocyclic compounds containing quinoline or hydrogenated quinoline ring systems having no bond between the ring nitrogen atom and a non-ring member or having only hydrogen atoms or carbon atoms directly attached to the ring nitrogen atom with only hydrogen atoms or radicals containing only hydrogen and carbon atoms, directly attached to the ring carbon atoms having only hydrogen atoms, hydrocarbon or substituted hydrocarbon radicals, attached to the ring nitrogen atom
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/47—Quinolines; Isoquinolines
    • A61K31/485—Morphinan derivatives, e.g. morphine, codeine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/50—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
    • A61K47/51—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
    • A61K47/54—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an organic compound
    • A61K47/542—Carboxylic acids, e.g. a fatty acid or an amino acid
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/50—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
    • A61K47/51—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
    • A61K47/54—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an organic compound
    • A61K47/55—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an organic compound the modifying agent being also a pharmacologically or therapeutically active agent, i.e. the entire conjugate being a codrug, i.e. a dimer, oligomer or polymer of pharmacologically or therapeutically active compounds
    • A61K47/551—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an organic compound the modifying agent being also a pharmacologically or therapeutically active agent, i.e. the entire conjugate being a codrug, i.e. a dimer, oligomer or polymer of pharmacologically or therapeutically active compounds one of the codrug's components being a vitamin, e.g. niacinamide, vitamin B3, cobalamin, vitamin B12, folate, vitamin A or retinoic acid
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/50—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
    • A61K47/51—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
    • A61K47/56—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an organic macromolecular compound, e.g. an oligomeric, polymeric or dendrimeric molecule
    • A61K47/59—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an organic macromolecular compound, e.g. an oligomeric, polymeric or dendrimeric molecule obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds, e.g. polyureas or polyurethanes
    • A61K47/60—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an organic macromolecular compound, e.g. an oligomeric, polymeric or dendrimeric molecule obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds, e.g. polyureas or polyurethanes the organic macromolecular compound being a polyoxyalkylene oligomer, polymer or dendrimer, e.g. PEG, PPG, PEO or polyglycerol
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/50—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
    • A61K47/51—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
    • A61K47/62—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being a protein, peptide or polyamino acid
    • A61K47/64—Drug-peptide, drug-protein or drug-polyamino acid conjugates, i.e. the modifying agent being a peptide, protein or polyamino acid which is covalently bonded or complexed to a therapeutically active agent
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
    • C07D495/00—Heterocyclic compounds containing in the condensed system at least one hetero ring having sulfur atoms as the only ring hetero atoms
    • C07D495/02—Heterocyclic compounds containing in the condensed system at least one hetero ring having sulfur atoms as the only ring hetero atoms in which the condensed system contains two hetero rings
    • C07D495/04—Ortho-condensed systems
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K5/00—Peptides containing up to four amino acids in a fully defined sequence; Derivatives thereof
    • C07K5/04—Peptides containing up to four amino acids in a fully defined sequence; Derivatives thereof containing only normal peptide links
    • C07K5/06—Dipeptides
    • C07K5/06008—Dipeptides with the first amino acid being neutral
    • C07K5/06017—Dipeptides with the first amino acid being neutral and aliphatic
    • C07K5/06026—Dipeptides with the first amino acid being neutral and aliphatic the side chain containing 0 or 1 carbon atom, i.e. Gly or Ala
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K5/00—Peptides containing up to four amino acids in a fully defined sequence; Derivatives thereof
    • C07K5/04—Peptides containing up to four amino acids in a fully defined sequence; Derivatives thereof containing only normal peptide links
    • C07K5/06—Dipeptides
    • C07K5/06008—Dipeptides with the first amino acid being neutral
    • C07K5/06017—Dipeptides with the first amino acid being neutral and aliphatic
    • C07K5/06034—Dipeptides with the first amino acid being neutral and aliphatic the side chain containing 2 to 4 carbon atoms
    • C07K5/06052—Val-amino acid
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K5/00—Peptides containing up to four amino acids in a fully defined sequence; Derivatives thereof
    • C07K5/04—Peptides containing up to four amino acids in a fully defined sequence; Derivatives thereof containing only normal peptide links
    • C07K5/08—Tripeptides
    • C07K5/0802—Tripeptides with the first amino acid being neutral
    • C07K5/0804—Tripeptides with the first amino acid being neutral and aliphatic
    • C07K5/0806—Tripeptides with the first amino acid being neutral and aliphatic the side chain containing 0 or 1 carbon atoms, i.e. Gly, Ala
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K5/00—Peptides containing up to four amino acids in a fully defined sequence; Derivatives thereof
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    • C07K5/08—Tripeptides
    • C07K5/0802—Tripeptides with the first amino acid being neutral
    • C07K5/0804—Tripeptides with the first amino acid being neutral and aliphatic
    • C07K5/0808—Tripeptides with the first amino acid being neutral and aliphatic the side chain containing 2 to 4 carbon atoms, e.g. Val, Ile, Leu
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K5/00—Peptides containing up to four amino acids in a fully defined sequence; Derivatives thereof
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    • C07K5/08—Tripeptides
    • C07K5/0802—Tripeptides with the first amino acid being neutral
    • C07K5/0812—Tripeptides with the first amino acid being neutral and aromatic or cycloaliphatic

Definitions

  • Opioids are highly effective as analgesics and are commonly prescribed for the treatment of acute and chronic pain. They are also commonly used as antitussives. The opioids, however, also produce euphoria and are highly addictive. As a result, they are often abused with far reaching social and health related consequences.
  • any pharmaceutical composition containing an opioid agonist be made as abuse-resistant or abuse-deterrent as practical. Illicit users often will attempt to circumvent the extended release properties of these dosage forms by injecting or otherwise misusing the product in order to achieve an immediate release of the opioid agonist.
  • Levorphanol ((-)-17-methylmorphinan-3-ol) is the (-)-isomer and one of two enantiomers of 17-methylmorphinan-3-ol. The other enantiomer is dextrorphan ((+)-17- methylmorphinan-3-ol).
  • a 1 :1 mixture of both enantiomers (levorphanol and dextrorphan) is referred to as racemorphan.
  • conjugation of those various different enantiomers may impact the various properties observed for the resultant levorphanol or dextrorphan conjugate, formulation and/or end product.
  • conjugation to levorphanol, dextrorphan, or a mixture thereof may create new enantiomers or diastereomers that may affect their resulting pharmacodynamic, pharmacological and/or pharmacokinetic properties.
  • Levorphanol is a narcotic analgesic, which interacts predominantly with receptors in the central nervous system (CNS). It has a wide range of pharmacological activities including ⁇ -opioid agonism, ( ⁇ -opioid receptor (MOR)), ⁇ -opioid receptor agonism (DOR), ⁇ and K 2 -opioid receptor agonism (KOR), and the nociceptin receptor (NOP), as well as an NMDA (N-methyl-D-aspartate) receptor antagonist and a reuptake inhibitor of both serotonin-norepinephrine (SNRI) and norepinephrine.
  • ⁇ -opioid agonism ⁇ -opioid receptor (MOR)
  • DOR ⁇ -opioid receptor agonism
  • KOR K 2 -opioid receptor agonism
  • NOP nociceptin receptor
  • NMDA N-methyl-D-aspartate
  • This multimodal pharmacological profile may be effective for the treatment of CNS conditions including, but not limited to, pain, neuropathic pain, cancer pain, opioid-induced hyperalgesia, pain syndromes that are refractory to other analgesic medications, post-therapeutic neuralgia, depression, narcolepsy and hyperalgesia.
  • the present technology utilizes covalent conjugation of the opioid levorphanol with certain oxoacids, polyethylene glycols (PEG or PEO), and/or vitamin compounds to decrease its potential for causing overdose or abuse by requiring the active levorphanol to be released through enzymatic or metabolic breakdown of the conjugate in vivo.
  • the present technology also provides methods of delivering levorphanol as conjugates that release the levorphanol following oral administration while being resistant to abuse by circuitous routes such as intravenous (“shooting”) injection and intranasal administration (“snorting”).
  • the compounds and conjugates of this disclosure may be administered alone, or combined with other CNS agents, for the treatment of CNS conditions, including, but not limited to, pain, neuropathic pain, cancer pain, opioid-induced hyperalgesia, pain syndromes that are refractory to other analgesic medications, post-therapeutic neuralgia, depression, narcolepsy and hyperalgesia.
  • the present technology utilizes conjugation of the opioid levorphanol with certain oxoacids, polyethylene glycols (PEG or PEO), and/or vitamin compounds to decrease its potential for causing overdose or abuse by requiring the active levorphanol to be released through enzymatic or metabolic breakdown of the conjugate in vivo.
  • the present technology also provides methods of delivering levorphanol as conjugates that release the levorphanol following oral administration while being resistant to abuse by circuitous routes such as intravenous (“shooting”) injection and intranasal administration (“snorting”).
  • Advantages of certain embodiments of the levorphanol prodrugs of the present technology include, but are not limited to, reduced drug abuse potential, reduced or eliminated opioid induced constipation (OIC), reduced risk of chemical or physical manipulation resulting in full dosage of levorphanol release, reduced patient to patient variability in plasma concentrations compared to free levorphanol, improved dosage forms through modifications of the physical and chemical properties of the prodrugs.
  • OIC opioid induced constipation
  • the present technology provides an immediate release composition of conjugated levorphanol that allows delivery of the levorphanol into the blood system of a human or animal in a therapeutically bioequivalent manner upon oral administration.
  • the compositions/formulations of the current technology can lessen common side effects associated with unconjugated levorphanol and similar compounds.
  • the presently described technology in at least one aspect, provides a slow/sustained/controlled release composition of conjugated levorphanol that allows slow/sustained/controlled delivery of the levorphanol into the blood system of a human or animal within a therapeutic window upon, for example, oral administration.
  • the present technology provides a composition comprising at least one conjugate of levorphanol, and at least one oxoacid, polyethylene glycol, vitamin compound, or derivatives thereof.
  • the conjugate further comprises a linker, wherein the linker chemically bonds the at least one levorphanol with the at least one oxoacid, polyethylene glycol, vitamin compound, or derivatives thereof.
  • the present technology provides at least one conjugate of levorphanol, and at least one oxoacid, polyethylene glycol, vitamin compound, derivatives thereof, or combinations thereof.
  • the conjugate further comprises a linker, wherein the linker chemically bonds the at least one levorphanol with the at least one oxoacid, polyethylene glycol, vitamin compound, or derivatives thereof.
  • the present technology provides a composition comprising at least one conjugate of levorphanol, wherein the conjugate has the following general Formula I:
  • L is absent, or is — c— ⁇
  • Y is absent, or [A-X-Z] n where A, X, Z are independently absent or selected from -O-, -S- or -(CR 1 R 2 ) k -
  • R 1 , R 2 are independently selected from H, alkyl, aryl, alkylaryl, alkoxy, haloalkyl, or haloaryl
  • n and k are independently 1 -4
  • G m is absent or selected independently for each repeating subunit from H, oxoacid, polyethylene glycol having from 2 to 5 ethylene oxide units, or a vitamin compound, and m is 1 -4, except that m is 1 when G is a hydrogen atom;
  • the present technology provides at least one prodrug or conjugate having the structure of general Formula I.
  • the present technology provides at least one prodrug composition comprising at least one conjugate of levorphanol, derivatives thereof or combinations thereof and at least one oxoacid, polyethylene glycol, vitamin compound, or derivatives thereof.
  • the prodrug composition may also comprise combinations of different levorphanol conjugates, and/or one or more active ingredients, additives, adjuvants, or combinations thereof.
  • the conjugate of levorphanol of the present technology may be combined with one or more levorphanol conjugates described in U.S. application no. 62/485,891 , filed on April 14, 2017, and/or one or more dextrorphan conjugates described in U.S. application no.
  • the present technology provides at least one prodrug composition comprising at least one conjugate, wherein the at least one conjugate can be, for example, 3-Val-levorphanol; 3-(acetyl-Val)-levorphanol; 3-(PhePhePhe)- levorphanol; 3-(ValValPhe)-levorphanol; 3-(AlaAlaVal)-levorphanol; 3-(GlyGlyAla)- levorphanol; 3-hippuryl-levorphanol; 3-(N-acetyl-Tyr)-levorphanol; 3-(N-acetyl-lle)- levorphanol; 3-(ProProPhe)-levorphanol; 3-(GlyGly)-levorphanol; 3-(ValGly)- levorphanol; 3-(AlaPro)-levorphanol; 3-cinnamoyl-levorphano
  • the present technology provides a method for chemically synthesizing any of the levorphanol conjugates of the present technology by performing the appropriate steps to conjugate levorphanol to at least one ligand.
  • the present technology provides a method for treating a human or animal patient having a disease, disorder or condition requiring or mediated by binding of an opioid to the opioid receptors and/or binding of an NMDA antagonist to the NMDA receptor of the patient, comprising orally administering to the patient a pharmaceutically effective amount of at least one levorphanol conjugate of the present technology.
  • the present technology provides a pharmaceutical kit comprising a specified amount of individual doses in a package, each dose comprising a pharmaceutically effective amount of at least one conjugate of levorphanol.
  • Figure 1 Chemical structures of some hydroxybenzoates for use in the making of the conjugates of the present technology.
  • Figure 2 Chemical structures of some aminobenzoic acids for use in the making of the conjugates of the present technology.
  • Figure 3 Chemical structures of some heteroaryl carboxylic acids for use in the making of the conjugates of the present technology.
  • Figure 4 Chemical structures of some phenylacetates for use in the making of the conjugates of the present technology.
  • Figure 5 Chemical structures of some benzylacetates for use in the making of the conjugates of the present technology.
  • Figure 7. Chemical structures of some dicarboxylic acids for use in the making of the conjugates of the present technology.
  • Figure 8 Chemical structures of some tricarboxylic acids for use in the making of the conjugates of the present technology.
  • Figure 9 Chemical structures of some standard amino acids for use in the making of the conjugates of the present technology.
  • Figure 10 Chemical structures of some non-standard amino acids for use in the making of the conjugates of the present technology.
  • Figure 1 1 Chemical structures of some synthetic amino acids for use in the making of the conjugates of the present technology.
  • Figure 12A Chemical structures of some water soluble vitamins for use in the making of the conjugates of the present technology.
  • Figure 12B Chemical structures of some fat soluble vitamins for use in the making of the conjugates of the present technology.
  • Figure 14 Oral PK curves comparing 3-Phe-levorphanol conjugate with unconjugated levorphanol in rats.
  • Figure 15 Oral PK curves comparing 3-(PhePhePhe)-levorphanol conjugate with unconjugated levorphanol in rats.
  • Figure 17 Oral PK curves comparing 3-(acetyl-Tyr)-levorphanol conjugate with unconjugated levorphanol in rats.
  • Figure 18 Oral PK curves comparing 3-(acetyl-Val)-levorphanol conjugate and 3-(acetyl-Val-OCH 2 OC(O))-levorphanol conjugate with unconjugated levorphanol in rats.
  • Figure 20 Oral PK curves comparing 3-(GlyGly)-levorphanol conjugate, 3- (ValGly)-levorphanol conjugate, and 3-(AlaPro)-levorphanol conjugate, with unconjugated levorphanol in rats.
  • Figure 21 Oral PK curves comparing 3-(acetyl-OCH 2 OC(O))-levorphanol conjugate and 3-cinnamoly-levorphanol conjugate with unconjugated levorphanol in rats.
  • Figure 22 Oral PK curves comparing 3-(butanoyl-OCH 2 OC(O))-levorphanol conjugate with unconjugated levorphanol in rats.
  • Figure 23 Oral PK curves comparing 3-(H 2 N-(PEG)6-CH 2 CH 2 C(O))- levorphanol conjugate with unconjugated levorphanol in rats.
  • Figure 24 Intranasal PK curves comparing 3-Val-levorphanol conjugate with unconjugated levorphanol in rats.
  • Figure 25 Intranasal PK curves comparing 3-(ValValPhe)-levorphanol conjugate with unconjugated levorphanol in rats.
  • Figure 26 Intranasal PK curves comparing 3-(acetyl-Tyr)-levorphanol conjugate with unconjugated levorphanol in rats.
  • Figure 27 Intranasal PK curves comparing 3-(acetyl-lle)-levorphanol conjugate with unconjugated levorphanol in rats.
  • Figure 28 Intravenous PK curves comparing 3-Val-levorphanol conjugate with unconjugated levorphanol in rats.
  • the present technology provides compounds of, or compositions comprising oxoacids, polyethylene glycols (PEG or PEO), and/or vitamin compounds chemically conjugated to levorphanol to form novel prodrugs and conjugates of levorphanol.
  • the chemical bond between these two moieties can be established by reacting the C-3 hydroxyl of levorphanol with the activated carboxylic acid function of an oxoacid or some vitamin compounds.
  • the hydroxyl group of an alcohol, hydroxyacid, hydroxyamino acid, or some vitamin compounds are conjugated to the C-3 of levorphanol.
  • a hydroxyacid is used as linker that is connected to the C-3 of levorphanol on one end (by reaction with its hydroxyl group) and to an alcohol, hydroxyacid, hydroxyamino acid, or vitamin compound on the other end (by reaction with its carboxyl group).
  • a dicarboxylic acid is used as a linker that is connected to the C-3 of levorphanol on one end and to an alcohol, hydroxyacid, hydroxyamino acid, or vitamin compound on the other end.
  • opioid is meant to include any drug that activates the opioid receptors found in the brain, spinal cord and gut.
  • opioids There are four broad classes of opioids: naturally occurring opium alkaloids, such as morphine (the prototypical opioid) codeine, and thebaine; endogenous opioid peptides, such as endorphins; semi-synthetics such as heroine, oxycodone and hydrocodone that are produced by modifying natural opium alkaloids (opiates) and have similar chemical structures; and pure synthetics such as fentanyl and methadone that are not produced from opium and may have very different chemical structures than the opium alkaloids.
  • naturally occurring opium alkaloids such as morphine (the prototypical opioid) codeine, and thebaine
  • endogenous opioid peptides such as endorphins
  • semi-synthetics such as heroine, oxycodone and hydrocodone that are produced by modifying natural opium alkaloids (opiates) and have similar chemical
  • opioids are hydromorphone, oxymorphone, methadone, levorphanol, dihydrocodeine, meperidine, diphenoxylate, sufentanil, alfentanil, propoxyphene, pentazocine, nalbuphine, butorphanol, buprenorphine, meptazinol, dezocine, and pharmaceutically acceptable salts thereof.
  • the term "levorphanol” herein means (-)-17-methylmorphinan-3-ol, including all salt forms thereof.
  • the conjugates contain levorphanol in a racemic mixture (racemorphan). In other embodiments, the levorphanol conjugates are not in a racemic mixture.
  • the resulting prodrug conjugates can be optically active mixtures of isomers, racemic mixtures, single isomers or combinations thereof.
  • “normative patient” as used herein means a patient that, in general, meets or requires standard and/established treatment modalities, treatment guidelines, prescribing guidelines, among others to achieve a variety of pharmaceutical and/or therapeutic outcomes.
  • conjugate means a compound or substance formed by bonding two or more chemical compounds or substances in such a way that the bonding is reversible in vivo.
  • a conjugate is the resultant compound formed by bonding at least one pharmaceutical or therapeutically active ingredient with at least one ligand, such as at least one oxoacid, or other substance or compound capable of being a ligand, which is then broken down in vivo into the pharmaceutical or therapeutically active ingredient and ligand.
  • ligand such as at least one oxoacid, or other substance or compound capable of being a ligand
  • the term "prodrug” refers to a substance converted from an inactive or less active form of a drug to an active drug in the body by a chemical or biological reaction.
  • the prodrug is a conjugate of at least one drug, levorphanol, and at least one oxoacid, for example.
  • the conjugates of the present technology are prodrugs and the prodrugs of the present technology are conjugates.
  • Prodrugs are often useful because, in some embodiments, they may be easier to administer or process than the parent drug. They may, for instance, be more bioavailable by oral administration whereas the parent drug is not.
  • the prodrug may also have improved solubility in pharmaceutical compositions over the parent drug.
  • An embodiment of a prodrug would be a levorphanol conjugate that is metabolized to reveal the active moiety.
  • a prodrug upon in vivo administration, a prodrug is chemically converted to the biologically, pharmaceutically or therapeutically more active form of the compound.
  • a prodrug is enzymatically metabolized by one or more steps or processes to the biologically, pharmaceutically or therapeutically active form of the compound.
  • a pharmaceutically active compound is modified such that the active compound will be regenerated upon in vivo administration.
  • the prodrug is designed to alter the metabolism, pharmacokinetics, or the transport characteristics of a drug in certain embodiments, to reduce or lessen side-effects or toxicity, to improve bioavailability and/or water solubility, to improve the flavor of a drug or to alter other characteristics or properties of a drug in other discrete embodiments.
  • the present technology provides at least one prodrug composition comprising at least one conjugate.
  • the at least one conjugate may comprise at least one levorphanol and at least one oxoacid, polyethylene glycol, vitamin compound, derivatives thereof, or combinations thereof.
  • the conjugate further comprises at least one linker. The linker chemically bonds the levorphanol to the oxoacid, polyethylene glycol, or vitamin compound via one or more covalent bonds.
  • the at least one prodrug or conjugate formed can be either a neutral (uncharged), a free acid, a free base or a pharmaceutically acceptable anionic salt form or salt mixtures with any ratio between positive and negative components.
  • anionic salt forms can include, but are not limited to, for example, acetate, /-aspartate, besylate, bicarbonate, carbonate, /-camsylate, /-camsylate, citrate, edisylate, formate, fumarate, gluconate, hydrobromide/bromide, hydrochloride/chloride, cZ-lactate, /-lactate, /,/-lactate, /,/-malate, /-malate, mesylate, pamoate, phosphate, succinate, sulfate, bisulfate, /-tartrate, /-tartrate, d, /-tartrate, meso-tartrate, benzoate, gluceptate, cZ-glucuronate, hybenzate, isethionate, malonate, methylsulfate, 2-napsylate, nicotinate, nitrate, orotate, ste
  • prodrugs/conjugates of the present technology undergo enzyme hydrolysis of the ligand/linker-levorphanol bond in vivo, which subsequently leads to a cascade reaction resulting in rapid regeneration of levorphanol and the respective oxoacid, polyethylene glycol, vitamin compound, or metabolites thereof and/or derivatives thereof.
  • the oxoacids, polyethylene glycols, vitamin compounds, or derivatives thereof, of the present technology are non-toxic or have very low toxicity at the given dose levels and are preferably known drugs, natural products, metabolites, or GRAS (Generally Recognized As Safe) compounds (e.g., preservatives, dyes, flavors, etc.) or non-toxic mimetics or derivatives thereof.
  • GRAS Generally Recognized As Safe
  • L is absent, or is — c— ;
  • Y is absent, or [A-X-Z] n
  • A, X, Z are independently absent or selected from -O-, -S- or -(CR 1 R 2 ) k -
  • R 1 , R 2 are independently selected from H, alkyl, aryl, alkylaryl, alkoxy, haloalkyl, or haloaryl
  • n and k are independently 1 -4
  • Gm is absent or selected independently for each repeating subunit from H, oxoacid, polyethylene glycol having from 2 to 5 ethylene oxide units, or a vitamin compound, and m is 1 -4, except that m is 1 when G is a hydrogen atom;
  • L and Y are absent, G is at least one oxoacid, and m is 1 -3.
  • Representative examples include, but are not limited to 3-Val-levorphanol; 3- (ValValPhe)-levorphanol; 3-(acetyl-Val)-levorphanol; 3-(PhePhePhe)-levorphanol; 3- (AlaAlaVal)-levorphanol; 3-(GlyGlyAla)-levorphanol; 3-hippuryl-levorphanol; 3- (ProProPhe)-levorphanol; 3-(GlyGly)-levorphanol; 3-(ValGly)-levorphanol; 3-(AlaPro)- levorphanol; 3-cinnamoyl-levorphanol; 3-(acetyl-Tyr)-levorphanol; 3-(N,O-diacetyl-Tyr)- levorphanol; and 3-(
  • L is present, A and Z are O, X is -(CR 1 R 2 )k- and G is at least one oxoacid and m is 1 -3.
  • Representative examples include, but are not limited to, 3-(N-acetyl-Val-OCH 2 OC(O))-levorphanol; 3-(cinnamoyl-OCH 2 OC(O))-levorphanol; 3-(benzoyl-OCH 2 OC(O)-levorphanol; 3-(butanoyl-OCH2OC(O))-levorphanol; 3-(N,O- acetyl-Lys-OCH 2 OC(O))-levorphanol.
  • L and Y are absent, and G is a vitamin compound.
  • Representative examples include, but are not limited to, 3-biotinyl-levorphanol.
  • L is present, A, X and Z are absent, and G is a vitamin compound.
  • Representative examples include, but are not limited to, 3-(ascorbyl-C(O))- levorphanol.
  • L is present, Y is absent, m is 2 and G m can be represented as G 1 and G 2 where G 1 is a hydroxycarboxylic acid, and G 2 is a vitamin compound.
  • Representative examples include, but are not limited to 3-(biotinyl- glycoloyl)-levorphanol.
  • L is absent
  • Y is absent
  • m is 2
  • G m can be represented as G 1 and G 2 where G 1 is a dicarboxylic acid, and G 2 is a vitamin compound.
  • Representative examples include, but are not limited to 3-(thiaminyl- succinoyl)-levorphanol.
  • L is present, A is -CR 1 R 2 -, X is absent, Z is -CR 1 R 2 - or absent, and G is polyethylene glycol.
  • Representative examples include, but are not limited to 3-(N3-PEG 4 -CH 2 CH 2 C(O))-levorphanol; 3-(H 2 N-PEG 5 -CH 2 CH 2 C(O))- levorphanol; and 3-(H 2 N-(PEG) 6 -CH 2 CH 2 C(O))-levorphanol.
  • L is present, A is oxygen, X and Z are -(CR 1 R 2 )k- and G is a hydrogen atom.
  • Representative examples include, but are not limited to, 3- (ethoxy-C(O))-levorphanol.
  • L is present, A is -(CR 1 R 2 )k- X and Z are absent, and G is acetic acid.
  • Representative examples include, but are not limited to 3-(acetyl- OCH 2 C(O))-levorphanol and 3-(acetyl-OCH(phenyl)C(O))-levorphanol.
  • Organic oxoacids i.e., oxyacids, oxo acids, oxy-acids, oxiacids, oxacids
  • Organic acids include carboxylic acids.
  • Carboxylic acids are widespread in nature (naturally occurring), but carboxylic acids can also be non-natural (synthetic).
  • Carboxylic acids can be categorized into numerous classes based on their molecular structure or formula, and many of the different classes may overlap.
  • carboxylic acids of the present technology can be grouped into the following categories: aryl carboxylic acids, aliphatic carboxylic acids, dicarboxylic, polycarboxylic acids, and amino acids.
  • Some embodiments of the present technology provide oxoacids conjugated to levorphanol, where the carboxylic acid group is directly attached to an aryl moiety.
  • Carboxylic acids directly attached to the aryl moiety include benzoates and heteroaryl carboxylic acids.
  • Benzoates are common in nature and include, for example but are not limited to, aminobenzoates (e.g., anthranilic acid analogs such as fenamates), aminohydroxybenzoates and hydroxybenzoates (e.g., salicylic acid analogs).
  • R 1 , R 2 , R 3 are independently selected from the group consisting of H, hydroxyl, amino, amine, amide, thiol, cyano, nitro, halogen, imine, alkyl, alkoxy, aryl, alkenyl, alkynyl, haloalkyl, alkylaryl, arylalkyl, heterocycle, arylalkoxy, cycloalkyl, cycloalkenyl, cycloalkynyl, carbonyl, thioether, selenoether, silyl, silyloxy, sulfonyl, and phosphonate.
  • Suitable hydroxyobenzoic acids can be found in Figure 1 and include, but are not limited to, benzoic acid, salicylic acid, acetylsalicylic acid (aspirin), 3-hydroxybenzoic acid, 4-hydroxybenzoic acid, 6-methylsalicylic acid, o,m,p-cresotinic acid, anacardic acids, 4,5-dimethylsalicylic acid, o,m,p-thymotic acid, diflunisal, o,m,p-anisic acid,
  • 2.3- dihydroxybenzoic acid (2,3-DHB), , ⁇ , ⁇ -resorcylic acid, protocatechuic acid, gentisic acid, piperonylic acid, 3-methoxysalicylic acid, 4-methoxysalicylic acid, 5-methoxysalicylic acid, 6-methoxysalicylic acid, 3-hydroxy-2-methoxybenzoic acid, 4-hydroxy-2-methoxybenzoic acid, 5-hydroxy-2-methoxybenzoic acid, vanillic acid, isovanillic acid, 5-hydroxy-3-methoxybenzoic acid, 2,3-dimethoxybenzoic acid,
  • 3- 0-methylgallic acid (3-OMGA), 4-0-methylgallic acid (4-OMGA), 3,4-O-dimethylgallic acid, syringic acid, 3,4,5-trimethoxybenzoic acid.
  • Suitable aminobenzoic acids include, but are not limited to, anthranilic acid, 3-aminobenzoic acid, 4,5-dimethylanthranilic acid, A/-methylanthranilic acid, AAacetylanthranilic acid, fenamic acids (e.g., tolfenamic acid, mefenamic acid, flufenamic acid), 2,4-diaminobenzoic acid (2,4-DABA), 2-acetylamino-4-aminobenzoic acid, 4-acetylamino-2-aminobenzoic acid, 2,4-diacetylaminobenzoic acid.
  • fenamic acids e.g., tolfenamic acid, mefenamic acid, flufenamic acid
  • 2,4-diaminobenzoic acid 2,4-diaminobenzoic acid
  • 2-acetylamino-4-aminobenzoic acid 2-acetyla
  • Suitable aminohydroxybenzoic acids include, but are not limited to,
  • the composition includes a benzoate conjugate comprising at least one levorphanol conjugated to at least one benzoic acid or benzoic acid derivative, salt thereof or combination thereof.
  • the benzoates include numerous benzoic acid analogs, benzoate derivatives with hydroxyl or amino groups or a combination of both.
  • the hydroxyl and amino functions may be present in their free form or capped with another chemical moiety, preferably but not limited to methyl or acetyl groups.
  • the phenyl ring may have additional substituents, but the total number of substituents can be four or less, three or less, or two or less.
  • the present technology provides a prodrug or composition comprising at least one conjugate of levorphanol and at least one heteroaryl carboxylic acid, a derivative thereof, or a combination thereof.
  • the heteroaryl carboxylic acid can be selected from Formula III, Formula IV, Formula V, Formula VI, Formula VII, Formula VIII, Formula IX, Formula X, or Formula XI where Formula III, Formula IV, Formula V, Formula VI, Formula VII, Formula VIII, Formula IX, Formula X, or Formula XI are:
  • R 1 , R 2 , R 3 are independently selected from the group consisting of H, hydroxyl, amino, amine, amide, thiol, cyano, nitro, halogen, imine, alkyl, alkoxy, aryl, alkenyl, alkynyl, haloalkyi, alkylaryl, arylalkyl, heterocycle, arylalkoxy, cycloalkyl, cycloalkenyl, cycloalkynyl, carbonyl, thioether, selenoether, silyl, silyloxy, sulfonyl, and phosphonate.
  • the carboxy group of the aryl carboxylic acids can be attached directly to the aromatic ring.
  • the present technology includes both carbon-only aryl groups and aryl groups with heteroatoms (heteroaryl).
  • the aryl or heteroaryl group which is connected directly to the carboxyl function can be a 6-membered ring and contains no or one heteroatom.
  • the additional substituted or unsubstituted aromatic or aliphatic rings can be fused to this 6-membered aryl or heteroaryl moiety.
  • the aryl carboxylic acids may have only one free carboxylic acid group and the total number of phenyl substituents on the 6-membered ring should be four or less, for example, 4, 3, 2 or 1 .
  • the aryl carboxylic acids of the present technology comprise a carboxylic group that is separated by one carbon from the aryl moiety.
  • These aryl carboxylic acids include branched phenylpropionic acids (i.e., 2-methyl-2-phenylacetates) or other derivatives of phenylacetate ( Figure 4).
  • the general structure of at least one phenylacetate of the present technology is represented by the following general Formula XII:
  • R 1 , R 2 , R 3 , R 4 , R 5 are independently selected from the group consisting of H, hydroxyl, amino, amine, amide, thiol, cyano, nitro, halogen, imine, alkyl, alkoxy, aryl, alkenyl, alkynyl, haloalkyl, alkylaryl, arylalkyl, heterocycle, arylalkoxy, cycloalkyl, cycloalkenyl, cycloalkynyl, carbonyl, thioether, selenoether, silyl, silyloxy, sulfonyl, and phosphonate.
  • Phenylacetic acids encompass various subsets of natural products, metabolites and pharmaceuticals.
  • One such pharmaceutically important subset is "profens", a type of NSAIDs and derivatives of certain phenylpropionic acids (e.g.,
  • phenylacetates of the present technology include, but are not limited to, phenylacetic acid (hydratropic acid), 2-hydroxyphenylacetic acid,
  • the aryl carboxylic acids of the present technology comprise a carboxylic group that is separated by two carbons from the aryl moiety.
  • These aryl carboxylic acids include benzylacetates ( Figure 5) and substituted derivatives thereof and analogs of cinnamic acid ( Figure 6). Both classes of compounds are abundant in nature in the form of natural products or metabolites (e.g., phenylalanine metabolism).
  • the general structures of some benzylacetates and cinnamates of the present technology are represented by the following general Formulas XIII and XIV:
  • R 1 , R 2 , R 3 , R 4 , R 5 , R 6 are independently selected from the group consisting of H, hydroxyl, amino, amine, amide, thiol, cyano, nitro, halogen, imine, alkyl, alkoxy, aryl, alkenyl, alkynyl, haloalkyl, alkylaryl, arylalkyl, heterocycle, arylalkoxy, cycloalkyl, cycloalkenyl, cycloalkynyl, carbonyl, thioether, selenoether, silyl, silyloxy, sulfonyl, and phosphonate.
  • Benzylacetic acids are defined by an ethylene group between the carboxyl function and the phenyl ring. Both the alkyl chain and the aryl moiety can have substituents, preferably hydroxyl groups. Some compounds of this class can be found in the phenylalanine metabolism.
  • benzylacetates of the present technology include, but are not limited to, benzylacetic acid, melilotic acid, 3-hydroxyphenylpropanoic acid, 4-hydroxyphenylpropanoic acid, 2,3-dihydroxyphenylpropanoic acid, /,/-phenyllactic acid, o,m,p-hydroxy- /,/-phenyllactic acid, or phenylpyruvic acid.
  • Cinnamic acids (3-phenylacrylic acids) ( Figure 6) are unsaturated analogs of benzylacetic acids. Cinnamates occur in two isomeric forms: cis (Z) and trans (£).
  • the cinnamate isomers of certain embodiments of the present technology are preferably, but not limited to, the trans configuration. Similar to benzylacetates, derivatives of cinnamic acid can be substituted on the alkenyl or aryl moiety of the molecule. Preferred substituents of some embodiments of the present technology are hydroxyl and methoxy groups. Certain cinnamates are thought to play a key role in phenylalanine metabolism.
  • cinnamates of the present technology include, but are not limited to, cinnamic acid, o,m,p-coumaric acid, 2,3-dihydroxycinnamic acid, 2,6-dihydroxycinnamic acid, caffeic acid, ferulic acid, isoferulic acid, 5-hydroxyferulic acid, sinapic acid, or 2-hydroxy-3-phenylpropenoic acid.
  • Suitable aliphatic carboxylic acids for use in the present technology include, but are not limited to, for example, saturated, monounsaturated, polyunsaturated, acetylenic, substituted (e.g., alkyl, hydroxyl, methoxy, halogenated, etc.), heteroatom containing or ring containing carboxylic acids.
  • saturated carboxylic acids include, but are not limited to, for example, methanoic, ethanoic, propanoic, butanoic, pentanoic, hexanoic, heptanoic, octanoic, 2-propylpentanoic acid, nonanoic, decanoic, dodecanoic, tetradecanoic, hexadecanoic, heptadecanoic, octadecanoic, or eicosanoic acid.
  • Suitable monounsaturated carboxylic acids for practice of the present technology include, but are not limited to, for example, 4-decenoic, 9-decenoic, 5-lauroleic, 4-dodecenoic, 9-tetradecenoic, 5-tetradecenoic, 4-tetradecenoic, 9-hexadecenoic, 6-hexadecenoic, 6-octadecenoic, or 9-octadecenoic acid.
  • Suitable polyunsaturated carboxylic acids for use in the present technology include, but are not limited to, for example, sorbic, octadecadienoic, octadecatrienoic, octadecatetraenoic, eicosatrienoic, eicosatetraenoic, eicosapentaenoic, docosapentaenoic, or docosahexaenoic acids.
  • Suitable acetylenic carboxylic acids for use in the present technology include, but are not limited to octadecynoic, octadecenynoic, 6,9-octadecenynoic, heptadecenynoic, tridecatetraenediynoic, tridecadienetriynoic, octadecadienediynoic, heptadecadienediynoic, octadecadienediynoic, octadecenediynoic, or octadecenetriynoic acids.
  • Suitable substituted carboxylic acids for practice of the present technology include, but are not limited to, for example, methylpropanoic, isovaleric, methylhexadecanoic, 8-methyl-6-nonenoic, methyloctadecanoic, trimethyloctacosanoic, trimethyltetracosenoic, heptamethyltriacontanoic, tetramethylhexadecanoic, tetramethylpentadecanoic, lactic, glyceric, glycolic, threonic, 3-hydroxypropionic, hydroxyoctadecatrienoic, hydroxyoctadecenoic, hydroxytetracosanoic, 2-hydroxybutyric, 3-hydroxybutyric, 4-hydroxybutyric, 4-hydroxypentanoic, hydroxyoctadecadienediynoic, hydroxyoctadecadienoic, 10-hydroxydecanoic, hydroxyde
  • Suitable examples of heteroatom containing carboxylic acids include, but are not limited to, for example, 9-(1 ,3-nonadienoxy)-8-nonenoic, 9-(1 ,3,6-nonatrienoxy)-8-nonenoic, 12-(1 -hexenoxy)-9,1 1 -dodecadienoic,
  • Suitable examples of ring containing carboxylic acids include, but are not limited to, for example, 10-(2-Hexylcyclopropyl)decanoic,
  • the levorphanol, derivatives thereof or combinations thereof can be conjugated to one or more dicarboxylic acids or tricarboxylic acids.
  • Dicarboxylic acids are compounds with two carboxyl groups with a general formula of HOOC-R-COOH, where R can be an alkyl, alkenyl, alkynyl or aryl group, or derivatives thereof.
  • Dicarboxylic acids can have straight carbon chains or branched carbon chains. The carbon chain length may be short or long.
  • Polycarboxylic acids are carboxylic acids with three or more carboxyl groups.
  • Suitable examples of dicarboxylic and tricarboxylic acids for the practice of the present technology include, but are not limited to, for example, oxalic, malonic, succinic, glutaric, adipic, pimelic, suberic, azelaic, sebacic, brassylic, thapsic, malic, tartaric, dihydroxymesoxalic, -hydroxyglutaric, methylmalonic, meglutol, diaminopimelic, carbamoyl aspartic, fumaric, maleic, mesaconic, 3-methylglutaconic, traumatic, phthalic acid, isophthalic, terephthalic, dipicolinic, citric acid, isocitric, carballylic, or trimesic acid.
  • Amino acids are one of the most important building blocks of life. They constitute the structural subunit of proteins, peptides, and many secondary metabolites. In addition to the 22 standard (proteinogenic) amino acids that make up the backbone of proteins, there are hundreds of other natural (non-standard) amino acids that have been discovered either in free form or as components in natural products.
  • the amino acids used in some embodiments of the prodrugs of this invention include natural amino acids, synthetic (non-natural, unnatural) amino acids, and their derivatives. Standard Amino Acids
  • the standard amino acids include alanine, arginine, asparagine, aspartic acid, cysteine, glutamic acid, glutamine, glycine, histidine, isoleucine, leucine, lysine, methionine, phenylalanine, proline, pyrrolysine, selenocysteine, serine, threonine, tryptophan, tyrosine and valine.
  • These standard amino acids have the general structure shown in Figure 9, where R represents the side chain on the a-carbon.
  • Non-standard amino acids can be found in proteins created by chemical modifications of standard amino acids already incorporated in the proteins. This group also includes amino acids that are not found in proteins but are still present in living organisms either in their free form or bound to other molecular entities. Non-standard amino acids occur mostly as intermediates in metabolic pathways of standard amino acids and are not encoded by the genetic code.
  • non-standard amino acids include but are not limited to ornithine, homoarginine, citrulline, homocitrulline, homoserine, theanine, ⁇ -aminobutyric acid, 6-aminohexanoic acid, sarcosine, cartinine, 2-aminoadipic acid, pantothenic acid, taurine, hypotaurine, lanthionine, thiocysteine, cystathionine, homocysteine, ⁇ -amino acids such as ⁇ -alanine, ⁇ -aminoisobutyric acid, ⁇ -leucine, ⁇ -lysine, ⁇ -arginine, ⁇ -tyrosine, ⁇ -phenylalanine, isoserine, ⁇ -glutamic acid, ⁇ -tyrosine, ⁇ -dopa (3,4-dihydroxy-L-phenylalanine), , -disubstituted amino acids such as 2-aminois
  • Synthetic amino acids do not occur in nature and are prepared synthetically. Examples include but are not limited to allylglycine, cyclohexylglycine, A/-(4-hydroxyphenyl)glycine, A/-(chloroacetyl)glycline ester,
  • 3- aminopentanoic acid 2-amino-octanedioic acid, 4-chloro- -phenylalanine, ⁇ -homoproline, ⁇ -homoalanine, 3-amino-3-(3-methoxyphenyl)propionic acid, A/-isobutyryl-cysteine, 3-amino-tyrosine, 5-methyl-tryptophan, 2,3-diaminopropionic acid,
  • levorphanol, derivatives thereof or combinations thereof is conjugated to a polyethylene glycol, or derivatives thereof.
  • the terminal hydroxyl group of the polyethylene glycol can be substituted with an amino, azide, or methoxy group.
  • suitable structures of polyethylene glycols include the following: wherein k is 1 -20 for these structures.
  • levorphanol, derivatives thereof, or combinations thereof is conjugated to one or more vitamin compounds.
  • the vitamin compounds include both water soluble and fat soluble vitamins or derivatives thereof.
  • Useful vitamin compounds are those that have one or more carboxylic acid groups, one or more hydroxyl groups, or one or more other reactive functional groups that can form a bond with levorphanol either directly or through one or more linkers.
  • water soluble vitamins that could be conjugated to levorphanol include biotin, folate (folic acid), niacin, pantothenic acid, riboflavin, thiamin, pyridoxine, and ascorbic acid.
  • fat soluble vitamins examples include Vitamin A (retinol), vitamin D 2 (ergocalciferol), vitamin D 3 (cholecalciferol), vitamin E (tocopherols and tocotrienols, including alpha, beta, gamma, and delta-tocopherol), and vitamin K (phylloquinone).
  • Vitamin A retinol
  • vitamin D 2 ergocalciferol
  • vitamin D 3 cholecalciferol
  • vitamin E tocopherols and tocotrienols, including alpha, beta, gamma, and delta-tocopherol
  • vitamin K phytoquinone
  • the levorphanol, derivatives thereof, or combinations thereof is conjugated to one or more organic oxoacids, polyethylene glycols, or vitamin compounds via one or more linkers.
  • Linker moieties of the present technology which connect the one or more organic oxoacids, polyethylene glycols, or vitamin compounds to the levorphanol, derivatives thereof or combinations thereof, can have the following general formulas:
  • X for these linker structures is selected from a representative group including alkyl, substituted alkyl, aryl, substituted aryl, arylalkyl, substituted alkylaryl, heteroalkyl, substituted heteroalkyl, heteroaryl, substituted heteroaryl, heterocycle, substituted heterocycle, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, cycloalkyl, substituted cycloalkyl, cycloalkenyl, substituted cycloalkenyl, cycloalkynyl, or substituted cycloalkynyl.
  • Preferred embodiments of the present technology include linkers where X is at least one aliphatic group. More preferred embodiments include linkers where X is at least one alkyl group.
  • prodrugs or conjugates of levorphanol can be given orally and, upon administration, release the active levorphanol after being hydrolyzed, it is believed, in the body.
  • the oxoacids, polyethylene glycols, and/or vitamin compounds of this invention are naturally occurring metabolites or mimetics thereof or pharmaceutically active compounds, these prodrugs can be easily recognized by physiological systems resulting in hydrolysis and release of levorphanol.
  • the claimed prodrugs themselves are either not active or have limited pharmacological activity and consequently may follow a metabolic pathway that differs from the parent drug.
  • the release of levorphanol into the systemic circulation can be controlled even when the prodrug is administered via routes other than oral.
  • the modified or conjugated levorphanol would release levorphanol similar to free or unmodified or unconjugated levorphanol.
  • the modified or conjugated levorphanol may have a more rapid release of levorphanol compared to unmodified or unconjugated levorphanol.
  • the modified or conjugated levorphanol would be released in a controlled or sustained manner. This controlled release can potentially alleviate certain side-effects and improve upon the safety profile of the parent drug.
  • side-effects may include, dizziness, lightheadedness, drowsiness, nausea, vomiting, constipation, stomach pain, rash, difficulty urinating, difficulty breathing and fainting.
  • levorphanol and other opioids are also highly addictive and prone to substance abuse.
  • levorphanol released from the conjugate may have a delayed T max and possibly lower C max than the parent drug.
  • the conjugates of the present technology when taken orally or by other non-oral routes, reduce, lessen, or do not provide the feeling of a "rush” even when taken orally at higher doses, but still maintain pain relief.
  • levorphanol conjugated with appropriate ligands of this invention is not hydrolyzed efficiently when administered via non-oral routes.
  • the prodrugs of the present technology do not generate as high plasma or blood concentrations of released levorphanol when injected or snorted compared to free levorphanol administered through these routes.
  • the conjugates of the present technology since they comprise ligands covalently bound to levorphanol, are not able to be physically manipulated to release the levorphanol from the conjugated levorphanol by methods, for example, of grinding up or crushing of solid forms.
  • Opioid induced constipation is a common side effect of pain treatment with opioids. It affects approximately 40-90% of the patients who are chronically taking opioid medication. Additionally, patients suffering from OIC may become resistant to laxative treatments. Although the mechanism is not yet fully understood, it is assumed that the binding of agonists to the peripheral ⁇ -opioid receptors in the gastrointestinal (Gl) tract is the primary cause of OIC. This opioid receptor activation impairs the coordination of the Gl function by the enteric nervous system (ENS) resulting in decreased gut motility by delaying the transit time of fecal content through interference with the normal tone and contractility of the bowels.
  • ENS enteric nervous system
  • the prodrugs of this invention have no or insignificant activity at the ⁇ -opioid receptors.
  • they are not subjected to enzymatic hydrolysis until they are absorbed in the gut. Consequently, the active levorphanol is effectively "cloaked" by the attached ligand and may bypass the peripheral ⁇ -opioid receptors without affecting the ENS thereby reducing or preventing OIC.
  • the at least one prodrug or conjugate of the present technology can be formulated into dosage forms that include but are not limited to tablet, capsule, caplet, troche, lozenge, powder, suspension, syrup, solution, oral thin film (OTF), oral strips, inhalation compounds, suppositories or transdermal patches.
  • the dosage forms are administered orally.
  • Preferred oral administration forms are solutions, syrups, suspensions, capsules, tablets and OTF.
  • Suitable dosing vehicles of the present technology include, but are not limited to, water, phosphate buffered saline (PBS), Tween in water, and PEG in water.
  • Solid dosage forms can optionally include at least one or more of the following types of excipients: antiadherents, binders, coatings, disintegrants, gel-forming agents, fillers, flavors and colors, glidants, lubricants, preservatives, sorbents and sweeteners, among others.
  • Oral formulations of the present technology can also be included in a solution, a suspension or a slurry in an aqueous liquid or a non-aqueous liquid.
  • the formulation can be an emulsion, such as an oil-in-water liquid emulsion or a water-in-oil liquid emulsion.
  • the oils can be administered by adding the purified and sterilized liquids to a prepared enteral formula, which is then placed in the feeding tube of a patient who is unable to swallow.
  • Soft gel or soft gelatin capsules may be prepared, for example by dispersing the formulation in an appropriate vehicle (vegetable oils are commonly used) to form a high viscosity mixture. This mixture is then encapsulated with a gelatin based film using technology and machinery known to those in the soft gel industry. The individual units so formed are then dried to constant weight.
  • an appropriate vehicle vegetable oils are commonly used
  • Chewable tablets may be prepared by mixing the formulations with excipients designed to form a relatively soft, flavored, tablet dosage form that is intended to be chewed rather than swallowed.
  • Conventional tablet machinery and procedures for example, direct compression and granulation, i.e., or slugging, before compression, can be utilized.
  • Those individuals involved in pharmaceutical solid dosage form production are versed in the processes and the machinery used, as the chewable dosage form is a very common dosage form in the pharmaceutical industry.
  • Film coated tablets for example may be prepared by coating tablets using techniques such as rotating pan coating methods or air suspension methods to deposit a contiguous film layer on a tablet.
  • Compressed tablets for example may be prepared by mixing the formulation with one or more excipients intended to add binding qualities to disintegration qualities.
  • the mixture is either directly compressed, or granulated and then compressed using methods and machinery known to those in the industry.
  • the resultant compressed tablet dosage units are then packaged according to market need, for example, in unit dose, rolls, bulk bottles, blister packs, etc.
  • the conjugates of the present technology can be formulated into formulations or co-formulations that may further comprise one or more additional components.
  • formulations can include biologically-acceptable carriers which may be prepared from a wide range of materials.
  • materials include diluents, binders and adhesives, lubricants, glidents, gel-forming agents, plasticizers, disintegrants, surfactants, colorants, bulking substances, flavorants, sweeteners and miscellaneous materials such as buffers and adsorbents in order to prepare a particular medicated formulation.
  • Binders may be selected from a wide range of materials such as hydroxypropylmethylcellulose, ethylcellulose, or other suitable cellulose derivatives, povidone, acrylic and methacrylic acid co-polymers, pharmaceutical glaze, gums, milk derivatives, such as whey, starches, and derivatives, as well as other conventional binders known to persons working in the art.
  • Exemplary non-limiting solvents are water, ethanol, isopropyl alcohol, methylene chloride or mixtures and combinations thereof.
  • Exemplary non-limiting bulking substances include sugar, lactose, gelatin, starch, and silicon dioxide.
  • the formulations of the present technology can include other suitable agents such as flavoring agents, preservatives and antioxidants.
  • antioxidants would be food acceptable and could include vitamin E, carotene, BHT or other antioxidants.
  • Other compounds which may be included by admixture are, for example, medically inert ingredients, e.g., solid and liquid diluents, such as lactose, dextrose, saccharose, cellulose, starch or calcium phosphate for tablets or capsules, olive oil or ethyl oleate for soft capsules and water or vegetable oil for suspensions or emulsions; lubricating agents such as silica, talc, stearic acid, magnesium or calcium stearate and/or polyethylene glycols; gelling agents such as colloidal clays; thickening agents such as gum tragacanth or sodium alginate, binding agents such as starches, arabic gums, gelatin, methylcellulose, carboxymethylcellulose or polyvinylpyrrolidone; disintegrating agents such as starch, alginic acid, alginates or sodium starch glycolate; effervescing mixtures; dyestuff; sweeteners; wetting agents such as lecit
  • fine powders or granules containing diluting, dispersing and/or surface-active agents may be presented in a draught, in water or a syrup, in capsules or sachets in the dry state, in a non-aqueous suspension wherein suspending agents may be included, or in a suspension in water or a syrup.
  • suspending agents may be included, or in a suspension in water or a syrup.
  • flavoring, preserving, suspending, thickening or emulsifying agents can be included.
  • Liquid dispersions for oral administration may be syrups, emulsions or suspensions.
  • the syrups may contain as carrier, for example, saccharose or saccharose with glycerol and/or mannitol and/or sorbitol.
  • a syrup for diabetic patients can contain as carriers only products, for example sorbitol, which do not metabolize to glucose or which metabolize only a very small amount to glucose.
  • the suspensions and the emulsions may contain a carrier, for example a natural gum, agar, sodium alginate, pectin, methylcellulose, carboxymethylcellulose or polyvinyl alcohol.
  • the ingredients mentioned herein are not intended to be exhaustive, and one of skill in the art will be able to formulate compositions using known or to be known ingredients.
  • levorphanol conjugates of the present technology can be combined with one or more active substances, such as different levorphanol conjugates, unconjugated levorphanol, narcotic and/or non-narcotic active ingredients, depending on intended indication.
  • active substances such as different levorphanol conjugates, unconjugated levorphanol, narcotic and/or non-narcotic active ingredients, depending on intended indication.
  • Examples of active pharmaceuticals that can be combined with the conjugates of the present technology include, but are not limited to, acetaminophen, phenylpropanolamine, ibuprofen, aspirin, toradol, ketorolac, diclofenac, pheniramine, chlorpheniramine, phenylephrine, pseudoephedrine, pyrilamine, dexyalamine, guaifenesin, codeine, oxycodone, oxymorphone, hydrocodone, hydromorphone, methadone, morphine, fentanyl, benzodiazepines, carbamezine, prochlorperazine, piperazines, piperazine derivatives, dextrorphan, dextromethorphan, magnesium salicylate, magnesium sulfate, and endothelin antagonists.
  • the conjugated levorphanol of the present technology can be formulated with one or a combination of these or other active substances or as a standalone
  • the amounts and relative percentages of the different active and inactive components of the formulations of the current technology can be modified, selected and adjusted in order to arrive at desirable formulations, dosages and dosage forms for therapeutic administration of the compounds, products, compositions, conjugates and prodrugs of the current technology.
  • compositions comprising the levorphanol conjugates or prodrugs may be used in methods of treating a patient having a disease, disorder, condition, or syndrome requiring or mediated by binding or inhibiting binding of an opioid to the opioid receptors and/or of an NMDA antagonist to the NMDA receptor of the patient.
  • the conjugate prodrugs or compositions of the present technology may be administered for the relief or treatment of pain, including acute, chronic, nociceptive, neuropathic, central, and/or peripheral pain.
  • compositions comprising the levorphanol conjugates of the present technology may be used as anesthetic or for the treatment of such conditions as hyperalgesia, Alzheimer's disease, pseudobulbar affect (PBA), and posttraumatic stress disorder (PTSD).
  • the compositions comprising the levorphanol conjugates of the present technology may be used in combination with quinidine for the treatment of PBA and/or PTSD.
  • compositions of the present technology may potentiate the effects of certain opioids, such as for example oxycodone, in suppressing neuropathic pain, thus potentially permitting a lower dose of oxycodone to be administered to a patient and thereby decreasing side effects of oxycodone treatment of neuropathic pain in said patient.
  • opioids such as for example oxycodone
  • NMDA receptors an ionotropic glutamate receptor
  • NMDA calcium channels The activated NMDA receptor facilitates the inward flow of calcium which in turn activates opioid receptor phosphorylation by protein kinase C. This phosphorylation inactivates the opioid receptor resulting in opioid tolerance and in central sensitization accompanied by enhanced nociception. The latter may manifest opioid-induced hyperalgesia (OIH) in the patient.
  • OIH opioid-induced hyperalgesia
  • Blocking the NMDA receptor by NMDA receptor antagonists such as levorphanol may disrupt the glutaminergic pathways, and thus provide relief for OIH and reduce opioid tolerance.
  • levorphanol may be suitable for opioid rotation.
  • Switching opioid therapy from, for example, oxycodone or morphine to levorphanol may improve patient analgesia through its unique opioid receptor activity profile as well as through blocking of NMDA receptors.
  • blockage of the NMDA receptor by levorphanol may treat neuropathic pain by modulating the action of glutamate in the glutaminergic transmission of nociceptive signals.
  • Treatment comprises orally administering to the patient a pharmaceutically effective amount of at least one conjugate of levorphanol as described in the present technology.
  • the patient may be a human or animal patient.
  • the term animal is used in the veterinary sense and does not include humans.
  • Human patients who may be treated include neonatal patients, pediatric patients, adolescent patients, adult patients, geriatric patients, elderly patients, and normative patients.
  • the conjugate can exhibit a lower, equivalent, or higher AUC when compared to an equivalent molar amount of unconjugated levorphanol, and can exhibit a slower, similar, or faster rate of release.
  • at least one conjugate can exhibit less variability in the oral PK profile when compared to unconjugated levorphanol.
  • dosages of the levorphanol conjugate of the present technology include, but are not limited to, formulations including from about 0.1 mg or higher, alternatively 0.5 mg or higher, alternatively from about 2.5 mg or higher, alternatively from about 5.0 mg or higher, alternatively from about 7.5 mg or higher, alternatively from about 10 mg or higher, alternatively from about 20 mg or higher, alternatively from about 30 mg or higher, alternatively from about 40 mg or higher, alternatively from about 50 mg or higher, alternatively from about 60 mg or higher, alternatively from about 70 mg or higher, alternatively from about 80 mg or higher, alternatively from about 90 mg or higher, alternatively from about 100 mg or higher of the levorphanol conjugate, and include any additional increments thereof, for example, 0.1 , 0.2, 0.25, 0.3, 0.4, 0.5, 0.6, 0.7, 0.75, 0.8
  • compositions comprising the levorphanol conjugates of the present technology could be orally administered at a dosing regimen of one time a day, alternatively two times a day, alternatively four times a day.
  • doses of the composition comprising the levorphanol conjugate could be administered at 1 dose every 4 to 6 hours, alternatively 1 to 2 doses every 4 to 6 hours, alternatively 6 to 8 hours, alternatively 6 doses in a 24 hour period.
  • compositions comprising the levorphanol conjugates of the present technology could be administered for a period of about 3 days, alternatively about 5 days, alternatively about 7 days, alternatively about 10 days, alternatively about 12 days, alternatively about 14 days, alternatively about 21 days, alternatively about 30 days, alternatively about 60 days, alternatively about 90 days, or alternatively about 120 days, among others.
  • rotational dosing utilizing one or more compositions of the present technology, or rotational dosing wherein one or more compositions of the present technology are used in conjunction with one or more opioids, such as, for example hydrocodone, hydromorphone, oxycodone, or oxymorphone, or conjugates of one or more opioids, is also envisaged.
  • opioids such as, for example hydrocodone, hydromorphone, oxycodone, or oxymorphone, or conjugates of one or more opioids
  • the present technology provides pharmaceutical kits comprising a levorphanol prodrug or composition of the present technology.
  • a specific amount of individual doses in a package contain a pharmaceutically and/or therapeutically effective amount of the levorphanol prodrug or conjugate of the present technology.
  • the kit comprises one or more blister packs containing the prodrug or composition of the present technology.
  • the kit can further include instructions for use of the kit.
  • the instructions for use are for the treatment of pain in a neonatal, pediatric, adolescent, adult, normative, or geriatric patient.
  • the instructions for use are for the treatment of any of the diseases, disorders, conditions, or syndromes identified above.
  • the specified amount of individual doses may contain from about 1 to about 1 00 individual dosages, alternatively from about 1 to about 60 individual dosages, alternatively from about 1 0 to about 30 individual dosages, including, about 1 , about 2, about 5, about 1 0, about 1 5, about 20, about 25, about 30, about 35, about 40, about 45, about 50, about 55, about 60, about 70, about 80, about 1 00, and include any additional increments thereof, for example, about 1 , about 2, about 5, about 1 0 and multiplied factors thereof, (e.g., about x 1 , about ⁇ 2, about ⁇ 2.5, about x5, about x 1 0, about ⁇ 1 00, etc.).
  • the present technology also provides methods for synthesizing the conjugated levorphanol of the present technology.
  • one or more protecting groups may be attached to any additional reactive functional groups that may interfere with the coupling to levorphanol. Any suitable protecting group may be used depending on the type of functional group and reaction conditions.
  • Some protecting group suitable for use in the present technology include, but are not limited to, acetyl (Ac), te/t-butyoxycarbonyl (Boc), benzyloxycarbonyl (Cbz), p-methoxybenzylcarbonyl (Moz), 9-fluorenylmethyloxycarbonyl (Fmoc), benzyl (Bn), p-methoxybenzyl (PMB), 3,4 dimethoxybenzyl (DMPM), p-methozyphenyl (PMP), tosyl (Ts), or amides (like acetamides, pthalamides, and the like).
  • a base may be required at any step in the synthetic scheme of prodrugs of levorphanol of this invention.
  • Suitable bases include, but are not limited to, 4-methylmorpholine (NMM), 4-(dimethylamino)pyridine (DMAP), A/,A/-diisopropylethylamine, lithium bis(trimethylsilyl)amide, lithium diisopropylamide (LDA), any alkali metal te/t-butoxide (e.g., potassium te/t-butoxide), any alkali metal hydride (e.g., sodium hydride), any alkali metal alkoxide (e.g., sodium methoxide), triethylamine or any other tertiary amine.
  • NMM 4-methylmorpholine
  • DMAP 4-(dimethylamino)pyridine
  • A/,A/-diisopropylethylamine lithium bis(trimethylsilyl)amide
  • Suitable solvents that can be used for any reaction at any step in the synthetic scheme of a prodrug of levorphanol of this invention include, but are not limited to, acetone, acetonitrile, butanol, chloroform, dichloromethane, dimethylformamide (DMF), dimethylsulfoxide (DMSO), dioxane, ethanol, ethyl acetate, diethyl ether, heptane, hexane, methanol, methyl te/t-butyl ether (MTBE), isopropanol, isopropyl acetate, diisopropyl ether, tetrahydrofuran, toluene, xylene or water.
  • an acid may be used to remove certain protecting groups.
  • Suitable acids include, but are not limited to, hydrochloric acid, hydrobromic acid, hydrofluoric acid, hydriodic acid, sulfuric acid, phosphoric acid, trifluoroacetic acid, acetic acid, citric acid, methanesulfonic acid, p-toluenesulfonic acid and nitric acid.
  • a catalytic hydrogenation may be used, e.g., palladium on charcoal in the presence of hydrogen gas.
  • reaction schemes that could be used to prepare some embodiments of the levorphanol conjugates of the present technology. It should be understood that the general reaction schemes provided are exemplary, and that one skilled in the art can modify or tailor the reaction schemes to achieve particular outcomes, purposes, and/or advantages.
  • the tripeptide derivative 10 was dissolved in 4N HCI in dioxane (8 mL) and stirred at room temperature for 2 hours. Solvent was evaporated, the residue was co-evaporated with IPAc and dried to give the tripeptide derivative 15 (0.09 g, 90%)
  • R 1 (CH 3 ) 2 CH-
  • n 2 Scheme 6.
  • 3-(Boc-Val)-levorphanol 3 was dissolved in dioxane (3 mL) and to the solution was added 4 N HCI in dioxane (10 mL). The reaction mixture was stirred at room temperature for 2.5 hours. The solvent was evaporated under reduced pressure, the residue was co-evaporated with IPAc and dried to give the 3-Val-levorphanol 6 as a white solid (0.55 g, 77% yield from levorphanol).
  • 3-(Val-Gly)-levorphanol was synthesized following the same method as described for compound 63 but using of levorphanol (0.193 g, 0.75 mmol) and Boc-Val- Gly-OH (0.227 g, 0.825 mmol). Yield of product 3-(Val-Gly)-levorphanol 64: 0.245 g (67% from levorphanol).
  • 3-(Ala-Pro)-levorphanol 65 was synthesized following the same method as described for compound 63 but using of levorphanol (0.193 g, 0.75 mmol) and Boc-Ala- Pro-OH (0.236 g, 0.825 mmol). Yield of product 3-(Ala-Pro)-levorphanol 65: 0.21 g (56% from levorphanol).
  • Example 2 Comparison of intranasal PK profiles of conjugates of Levorphanol in rats
  • a compound or composition comprising at least one conjugate of levorphanol having the following general formula:
  • L is absent, or is — c— ;
  • Y is absent, or [A-X-Z] n where A, X, Z are independently absent or selected from -O-, -S- or -(CR 1 R 2 ) k -
  • R 1 , R 2 are each independently selected from H, alkyl, aryl, alkyl aryl, alkoxy, haloalkyl, haloaryl n and k are independently 1 -4
  • G m is absent or selected independently for each repeating subunit from H, oxoacid, polyethylene glycol having from 2 to 5 ethylene oxide units, or a vitamin compound, and m is 1 -4, except m is 1 when G is H; or a pharmaceutically acceptable salt thereof.
  • carboxylic acid is an aliphatic carboxylic acid selected from the group consisting of saturated carboxylic acids, monounsatu rated carboxylic acids, polyunsaturated carboxylic acids, acetylenic carboxylic acids, substituted carboxylic acids, heteroatom containing carboxylic acids and ring containing carboxylic acids.
  • saturated carboxylic acid is selected from the group consisting of methanoic, ethanoic, propanoic, butanoic, pentanoic, hexanoic, heptanoic, octanoic, 2-propylpentanoic acid, pivalic acid, nonanoic, decanoic, dodecanoic, tetradecanoic, hexadecanoic, heptadecanoic, octadecanoic, and eicosanoic acid.
  • polyunsaturated carboxylic acid is selected from the group consisting of sorbic, octadecadienoic, octadecatrienoic, octadecatetraenoic, eicosatrienoic, eicosatetraenoic, eicosapentaenoic, docosapentaenoic, and docosahexaenoic acids.
  • acetylenic carboxylic acid is selected from the group consisting of octadecynoic, octadecenynoic, 6,9-octadecenynoic, heptadecenynoic, tridecatetraenediynoic, tridecadienetriynoic, octadecadienediynoic, heptadecadienediynoic, octadecadienediynoic, octadecenediynoic, and octadecenetriynoic acids.
  • 13- (2-cyclopentenyl)-6-tridecenoic 1 1 -cyclohexylundecanoic, 13-cyclohexyltridecanoic, 7-(3,4-dimethyl-5-pentylfuran-2-yl)heptanoic, 9-(4-methyl-5-pentylfuran-2-yl)nonanoic, 4-[5]-ladderane-butanoic, 6-[5]-ladderane-hexanoic, and 6-[3]-ladderane-hexanoic acid.
  • hydroxybenzoate is selected from the group consisting of salicylic acid, acetylsalicylic acid (aspirin), 3-hydroxybenzoic acid, 4-hydroxybenzoic acid, 6-methylsalicylic acid, o,m,p-cresotinic acid, anacardic acids, 4,5-dimethylsalicylic acid, o,m,p-thymotic acid, diflunisal, o,m,p-anisic acid, 2,3-dihydroxybenzoic acid (2,3-DHB), , ⁇ , ⁇ -resorcylic acid, protocatechuic acid, gentisic acid, piperonylic acid, 3-methoxysalicylic acid,
  • heteroaryl carboxylic acid is selected from the group consisting of nicotinic acid, isonicotinic acid, picolinic acid, 3-hydroxypicolinic acid, 6-hydroxynicotinic acid, citrazinic acid, 2,6-dihydroxynicotinic acid, kynurenic acid, xanthurenic acid, 6-hydroxykynurenic acid, 8-methoxykynurenic acid, 7,8-dihydroxykynurenic acid, and 7,8-dihydro-7,8-dihydroxykynurenic acid.
  • phenylacetate is selected from the group consisting of phenylacetic acid (hydratropic acid), 2-hydroxyphenylacetic acid, 3-hydroxyphenylacetic acid, 4-hydroxyphenylacetic acid, homoprotocatechuic acid, homogentisic acid, 2,6-dihydroxyphenylacetic acid, homovanillic acid, homoisovanillic acid, homoveratric acid, atropic acid, /,/-tropic acid, diclofenac, /,/-mandelic acid, 3,4-dihydroxy- /,/-mandelic acid, vanillyl- /,/-mandelic acid, isovanillyl- /,/-mandelic acid, ibuprofen, fenoprofen, carprofen, flurbiprofen, ketoprofen, and naproxen.
  • phenylacetic acid hydrophilic acid
  • 2-hydroxyphenylacetic acid 3-hydroxyphenylacetic acid
  • 4-hydroxyphenylacetic acid homoprotocatechuic acid
  • the carboxylic acid is a benzylacetate selected from the group consisting of benzylacetic acid, melilotic acid, 3-hydroxyphenylpropanoic acid, 4-hydroxyphenylpropanoic acid, 2,3-dihydroxyphenylpropanoic acid, /,/-phenyllactic acid, o,m,p-hydroxy- /,/-phenyllactic acid, and phenylpyruvic acid.
  • the carboxylic acid is a cinnamate, derivatives thereof, or combinations thereof.
  • cinnamate is selected from the group consisting of cinnamic acid, o,m,p-coumaric acid, 2,3-dihydroxycinnamic acid, 2,6-dihydroxycinnamic acid, caffeic acid, ferulic acid, isoferulic acid, 5-hydroxyferulic acid, sinapic acid, and 2-hydroxy-3-phenylpropenoic acid.
  • dicarboxylic acid is selected from the group consisting of oxalic, malonic, succinic, glutaric, adipic, pimelic, suberic, azelaic, sebacic, brassylic, thapsic, malic, tartaric, dihydroxymesoxalic, -hydroxyglutaric, methylmalonic, meglutol, diaminopimelic, carbamoyl aspartic, fumaric, maleic, mesaconic, 3-methylglutaconic, traumatic, phthalic acid, isophthalic, terephthalic, and dipicolinic acid.
  • the dicarboxylic acid is selected from the group consisting of oxalic, malonic, succinic, glutaric, adipic, pimelic, suberic, azelaic, sebacic, brassylic, thapsic, malic, tartaric, dihydroxymesoxalic, -hydroxyglutaric, methylmalonic, meglu
  • vitamin compound is a water soluble vitamin compound selected from biotin, folic acid, niacin, and pantothenic acid.
  • vitamin compound is a water soluble vitamin compound selected from ascorbic acid, riboflavin, thiamin, pantothenic acid, pyridoxine, pyridoxamine, and pyridoxal.
  • vitamin compound is a fat soluble vitamin compound selected from retinol, cholecalciferol, ergocalciferol, and tocopherols.
  • G 2 is a water soluble vitamin compound selected from ascorbic acid, riboflavin, thiamin, pantothenic acid, pyridoxine, pyridoxamine, and pyridoxal.
  • anionic salt form is selected from the group consisting of acetate, /-aspartate, besylate, bicarbonate, carbonate, /-camsylate, /-camsylate, citrate, edisylate, formate, fumarate, gluconate, hydrobromide/bromide, hydrochloride/chloride, cZ-lactate, /-lactate, /,/-lactate, /,/-malate, /-malate, mesylate, pamoate, phosphate, succinate, sulfate, bisulfate, /-tartrate, /-tartrate, d, /-tartrate, meso-tartrate, benzoate, gluceptate, /-glucuronate, hybenzate, isethionate, malonate, methylsulfate, 2-napsylate, nicotinate, nitrate
  • composition of paragraph 89 wherein the one or more excipients is at least one filler, at least one glidant, at least one binder, at least one diluent, at least one lubricant, at least one surfactant, at least one plasticizer, at least one disintegrant, or a combination thereof.
  • composition of paragraph 91 wherein the additional active pharmaceutical ingredient is hydromorphone, hydrocodone, oxycodone, oxymorphone, conjugates thereof, or combinations thereof.
  • additional active pharmaceutical ingredient is in the form of a second conjugate.
  • composition of paragraph 93, wherein the second conjugate is a dextrorphan conjugate.
  • a method of treating a patient having pain comprising orally administering to the patient a pharmaceutically effective amount of a composition comprising at least one conjugate of levorphanol and at least one oxoacid, polyethylene glycol, vitamin compound, or a combination thereof.
  • a method of using opioid rotation to treat pain in a patient who is determined to be refractory or non-responsive to a first opioid active pharmaceutical ingredient comprising administering to the patient a second active pharmaceutical ingredient, wherein the second active pharmaceutical ingredient is at least one conjugate of levorphanol and at least one oxoacid, polyethylene glycol, vitamin compound, or a combination thereof.
  • the first opioid active pharmaceutical ingredient is selected from the group consisting of hydromorphone, hydrocodone, oxycodone, oxymorphone, conjugates thereof, and combinations thereof.
  • a pharmaceutical kit comprising:
  • each dose comprises a pharmaceutically effective amount of at least one conjugate of levorphanol and at least one oxoacid, polyethylene glycol, vitamin compound, or a combination thereof.
  • kit further comprises:
  • kits for use of the kit in a method for treating pain in a human mal patient.

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Abstract

La technologie présentement décrite fournit des compositions d'un ou de plusieurs oxoacides, polyéthylène glycols, et composés de vitamine chimiquement conjugués au lévorphanol ((-)-17-méthylmorphinane-3-ol) pour former de nouveaux promédicaments et des compositions de lévorphanol.
PCT/US2018/027258 2017-04-14 2018-04-12 Promédicaments de levoranol et leurs procédés de fabrication et d'utilisation WO2018191472A1 (fr)

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JP7535569B2 (ja) 2019-08-11 2024-08-16 カッパ－ファーマ・リミテッド・ライアビリティ・カンパニー オピオイドヘキサジエノエート及び選択的に置換されたヘキサジエノエートによってオピオイド受容体の結合を改善する組成物並びに方法

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US11186585B2 (en) * 2018-08-17 2021-11-30 Kappa-Pharma LLC Compositions and methods of enhancing opioid receptor engagement by opioid hexadienoates and optionally substituted hexadienoates
US20210395260A1 (en) * 2018-08-17 2021-12-23 Kappa-Pharma LLC Compositions and methods of use for opioid hexadienoates and optionally substituted hexadienoates
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JP7535569B2 (ja) 2019-08-11 2024-08-16 カッパ－ファーマ・リミテッド・ライアビリティ・カンパニー オピオイドヘキサジエノエート及び選択的に置換されたヘキサジエノエートによってオピオイド受容体の結合を改善する組成物並びに方法

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